AccountId: 011433970860
ContactId: b18793e4-655a-40bc-aadf-2005a55d3bcf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 579650 ms
Total Talk Time (AGENT): 346821 ms
Total Talk Time (CUSTOMER): 181923 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/b18793e4-655a-40bc-aadf-2005a55d3bcf_20241231T13:47_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling
[AGENT][NEUTRAL] to
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] I can barely hear you. Oh, there you are.
[AGENT][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] Hi, can you hear me?
[AGENT][NEUTRAL] I can, yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi, I'm calling about a claim that I have just checking on the status.
[AGENT][NEUTRAL] OK, they say you're wanting to check claim status on a claim for yourself, is that correct?
[CUSTOMER][NEUTRAL] Yes, do you want me to give you I have the claim number. I'm online on your website so I can give you the claim number if you need me.
[AGENT][NEUTRAL] Yes, I
[AGENT][NEUTRAL] OK, yeah, well, that'll be OK. What is, um, first off, who am I speaking with?
[CUSTOMER][NEUTRAL] This is [PII]. Last name is [PII].
[AGENT][POSITIVE] Thank you, Ms. [PII]. What is a good callback number for you please, in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And your policy number?
[CUSTOMER][NEUTRAL] Uh, policy number is 246.
[CUSTOMER][NEUTRAL] 326 7.
[AGENT][NEUTRAL] OK, thank you. So give me a moment to get your information pulled up. And then once I do, I will have to verify several things with you first for security and also any information that is provided will be a verification of benefits and not a guarantee of payment. So first off, Morse, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah it's fine.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] In [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number we have for you is the same as the one you, well, actually, no, I'm sorry, the phone number we have on file is different than what you gave me. What is another contact number we could have for you?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, thank you. And is that still a valid number?
[CUSTOMER][NEUTRAL] Yes, that's my cell phone number.
[AGENT][NEUTRAL] Oh, OK. And lastly, your email address, please?
[CUSTOMER][NEUTRAL] Um, my, do you have my work number or my, um, I've got two emails. I don't know which one.
[AGENT][NEUTRAL] Mm, this could possibly be a work. I'm not 100%, but.
[CUSTOMER][NEUTRAL] Um, my work number is um [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, thank you very much for verifying all of your information. OK, and so on your claim is the 354582-2, is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Correct, that's correct.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] So yes, ma'am. I can see this claim was processed. It has been denied and give me a moment to look at the remarks.
[CUSTOMER][NEUTRAL] Why is it denied?
[AGENT][NEUTRAL] Yes, ma'am. Um, give me just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, several things, your, your primary insurance company paid full benefits, so there were no benefits payable, um.
[AGENT][NEGATIVE] There are 3 line items that were denied.
[AGENT][NEUTRAL] Stating benefits are payable only if your major medical insurance provider provides benefits. If this claim is later paid by your major medical insurance, please send the explanation of benefits showing benefits were paid.
[AGENT][NEUTRAL] And then there was one line item for date of service, [PII].
[CUSTOMER][NEUTRAL] [PII], we're not talking about the [PII] we're talking about a date of service of [PII], not from [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On this particular claim, there's multiple dates of service.
[CUSTOMER][NEUTRAL] OK, [PII] was a date that I went into the hospital and they never did surgery because the instruments were.
[CUSTOMER][NEUTRAL] We're not um not sterilized. So I never had surgery on [PII]. I had surgery on [PII].
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, so that's.
[AGENT][NEUTRAL] OK, so on [PII], it states according to this, that your primary insurance paid full benefits.
[AGENT][NEGATIVE] That there were no benefits payable.
[CUSTOMER][NEGATIVE] But there's a balance on it. How can they? I mean, there's still a balance that so they didn't pay for everything.
[AGENT][NEUTRAL] Now, I will be happy to connect you over Mr. [PII] to one of the examiners who reviews this type of claim to have them further go over uh more details on the information we've received and when I do transfer you, you will not have to re-verify any of your information. I'll give them all of that and let them know that that has been done. So, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so you won't have to redo that again.
[AGENT][NEUTRAL] Would you like for me to connect you so they can take a look at the paperwork with you that was received?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah that's great because otherwise I'm gonna have to see if there's any of the other bills that I've got can go here and I'm sure that today is probably the last day that can be done, correct?
[AGENT][NEUTRAL] No, ma'am. Actually, with APL we do not have a timely filing limit.
[AGENT][NEUTRAL] So that uh you can still submit any, you know, additional.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claims information that may be missing a for either these. Um, I do see there was a 620 data service, another line item for that thing that you said they didn't do the procedure and that was, yeah. So again, I'll just let them look at everything that was received with you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] No, no, no.
[CUSTOMER][POSITIVE] OK, that'd be great.
[AGENT][NEUTRAL] Um, to go over that. So, is there anything else that I can help you with before I transfer you?
[CUSTOMER][NEGATIVE] No, no, I don't think so because now like I said I've never done this before, but if there's nothing that I that you guys are gonna cover then I'm having this money taken out of my account for no reason at all.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And again, according to the remarks, your insurance, just based on what I can see, there wasn't on some of these things, there wasn't anything for us to pay according to what I'm looking at, that your primary, because it's, it helps, this policy helps you with your co-pays and deductibles and co-insurance amounts of coverage services, but several of these things look like your primary paid. There wasn't anything.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And see I've got an and see I've got another bill that I've got from the for the um anesthesiologist.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know there's another bill for the um the doctor's you know the doctor's office you know the doctor itself so I mean maybe that's something I need to you know granted they paid some of that too but I mean.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I don't know. I don't know. Maybe that's something I need to, you know, upload and, and send also, but I'll talk to the lady and or the gentleman, whoever you're gonna transfer me to and see what they say.
[AGENT][POSITIVE] OK, sure. OK, well, I'll be happy to get you connected and again, if that's all that I can help you with, thank you for calling APL. I hope you have a wonderful day and a very happy and safe [PII], [PII].
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Yes, ma'am, and thank you also. So, one moment, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Suffering.
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][NEUTRAL] Hey, [PII], it's [PII]. How are you today?
[CUSTOMER][POSITIVE] I'm good. How are you doing, [PII]?
[AGENT][NEGATIVE] Oh, well, I was thinking it might be a little slower today and less hectic than yesterday, but I think I was very wrong.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Oh wow.
[AGENT][NEUTRAL] At this point,
[AGENT][POSITIVE] But I hope you're doing great.
[CUSTOMER][POSITIVE] OK, thanks for the update.
[AGENT][NEUTRAL] So I have
[AGENT][NEUTRAL] Yeah. So I have an insured on the line who, um,
[AGENT][NEUTRAL] has got more questions on this claim that we reviewed. I went over her remarks with her, but
[AGENT][NEUTRAL] Um, anyway, she needs more information because she's saying it's
[AGENT][NEUTRAL] There's multiple dates of service on here for one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, the policy number is 2463267 [PII]. She's fully verified and she did give me a different number than what's on file. This I believe is her work number that she gave to me today, 815.
[AGENT][NEUTRAL] 282-7581.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, and it's the only claim that's out there for her. 354-582-2.
[CUSTOMER][NEUTRAL] OK, I'm pulling it up. You can send her over.
[AGENT][POSITIVE] All right. Well, thank you so very much and should I not talk to you again today, which I probably will at this rate, I hope that you have a very [PII].
[CUSTOMER][NEUTRAL] You do the same, [PII].
[AGENT][POSITIVE] Thank you, [PII]. OK, so just one moment. Now I'll release her to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.